Do you know how many decisions you make every day? Hint: it’s a whopping number. According to British psychology professor Eva Krockow, “Whether you’re making breakfast or deciding what to wear in the morning, your brain is making upward of 35,000 decisions each day… By the evening, you’re exhausted, but you can’t quite put your finger on why.” By that reasoning, decision-making will be especially taxing if you can’t make up your mind.

Many choices are of little importance. Choosing between dry cereal vs. oatmeal is not going to wear you down. However, having to be decisive when the stakes are high can be exhausting. In the case of choosing a cancer treatment—a potentially life-or-death situation—waffling can be a slippery slope, leading to “procrastination, indecisiveness, and even paralysis by analysis.” Being torn between options creates anxiety and pressure, two states that can drive you to mental and emotional fatigue.

Fortunately, when prostate cancer (PCa) is diagnosed early, it’s very treatable with high success rates. Many options exist, and the odds for equal cancer control among them are favorable. Many PCa patients are candidates for a focal approach that offers cancer control on a par with whole gland treatments like surgery or radiation, yet has superior rates of preserving urinary and sexual function.

At the Sperling Prostate Center, we are unique in offering three focal therapy methods: Focal Laser Ablation, TULSA, and Exablate MRI-guided Focused Ultrasound. Thanks to our state-of-the-art multiparametric MRI and our in-bore MRI-guided targeted biopsy, we have a high degree of confidence over which men are candidates for focal therapy. We assist each focal patient with deciding which method best suits his disease and lifestyle. When a patient feels good about his choice, it takes the stress and fatigue out of decision-making.

Occasionally, though, a biopsy result will raise suspicion that a patient carries a risky PCa cell line. In this case, a deeper analysis of the biopsy-obtained tissue is warranted. A genomic analysis of the biopsy obtained tissue is done to look for the presence of higher risk gene mutations. The absence of a dangerous aberration boosts confidence in the choice of a focal treatment.

This was recently demonstrated in a study of patients with lower risk PCa who were on Active Surveillance. Since they are leaving the whole gland untreated, it makes sense to take a deeper dive into these patients’ risk factors. The authors wrote, “Overall, participants understood the role of genomic testing in estimating their prostate cancer risk, and the test results increased their confidence in the decision for active surveillance.”^[i] This observation extends to PCa patients contemplating focal treatment. If their biopsy results warrant genomic analysis, and the results are negative for dangerous gene mutations, it reinforces confidence in focal treatment.

It is noteworthy that the research connecting genomic testing with increased confidence was done by a team of experts from five coast-to-coast academic centers of excellence, including Yale University (Connecticut), New York University, Northwestern University (Chicago), University of California San Diego, and University of California San Francisco. The team used structured in-depth interviews that were “focused on experiences with genomic testing during patients’ decision-making for prostate cancer management…”^[ii] The authors found that even when there were gaps in patient understanding of genomic results, having that information explained to them influenced their comfort with their choice.

Studies with cancer patients have found that patients do best when they are given more information, enabling them to be actively engaged in the decision-making process. At our Center, we strive to provide our patients with full information about their diagnosis and appropriate treatment options. To sum up, an informed patient is a confident patient.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] Leapman MS, Sutherland R, Gross CP, Ma X et al. Patient experiences with tissue-based genomic testing during active surveillance for prostate cancer. BJUI Compass. 2023 Aug 15;5(1):142-149.
[ii] Ibid.